Amenorrhea

The term menstrual disorders refers to any of a number of conditions that are related to the menstrual cycle. Menstruation is the shedding of the lining of the uterus (the endometrium) each month, also referred to as the menstrual period. Menstrual periods usually last for five to seven days. Amenorrhea is the term used to describe the absence of menstrual periods. There are two types of amenorrhea. Primary amenorrhea refers to menstrual periods that have not begun by the age of 16. Secondary amenorrhea refers to the absence of three or more menstrual periods in a woman who has had regular periods up to that point. A menstrual period is considered late if it is five or more days overdue according to the woman's usual pattern of periods. A period is considered missed if there is no menstrual flow for 6 or more weeks.

Causes

Causes of Primary amenorrhea

• Problems with the hypothalamus: Hypothalamus is the area in brain that regulates menstrual periods. Eating disorders, more exercise and psychological stress can be affected the hypothalamus.
• Lack of reproductive organs: when a baby girl born without cervix, uterus and vagina. Her reproductive system is incomplete and didn't work normally. A girl has not menstrual period due to any major parts in reproductive system.
• Chromosomal abnormalities: sometimes chromosomal abnormalities can be caused absence of menstruation. Chronic illness also the cause of amenorrhea.
• Pituitary disease: Pituitary gland also regulate the menstrual periods. But sometimes a tumor may stop the work of pituitary gland.
• Structural abnormality to the vagina: wall in the vagina may stop the blood from cervix and uterus.   Amenorrhea can be developed due to abnormal structure of vagina.

• Pregnancy: pregnancy is the main cause of secondary amenorrhea.
• Stress: psychological stress is also cause of secondary amenorrhea. Stress affected the hypothalamus area that regulate the menstrual periods.
• Medication: medications such as antipsychotic, antidepressants and chemotherapy drugs may causes of amenorrhea.
• More exercise and low body weight: low body weight may disrupt hormonal functions and eating disorder like anorexia can be caused amenorrhea. Women who participate in gymnastics and long-distance running may develop amenorrhea. Other causes include high energy expenditure and stress.
• Thyroid malfunction: Thyroid commonly causes of irregular of menstrual periods. Pituitary gland produces the prolactin hormone. Unbalanced prolactin level may interrupt the menstrual periods.

Signs and symptoms

The main indication that you might have amenorrhea is that you don't have menstrual periods. Here's what to look for in primary and secondary amenorrhea:

• Primary amenorrhea. You have no menstrual period by age 16.
• Secondary amenorrhea. You have no periods for three to six months or longer.

Depending on the cause of amenorrhea, you might experience other signs or symptoms along with the absence of periods, such as milky nipple discharge, headache, vision changes, hair loss or excess facial hair.

Diagnosis

Diagnosis begins with a gynecologist evaluating a female's medical history and a complete physical examination including a pelvic examination. A diagnosis of amenorrhea can only be certain when the physician rules out other menstrual disorders, medical conditions, or medications that may be causing or aggravating the condition. In addition, a diagnosis of amenorrhea requires that a female has missed at least three consecutive menstrual cycles, without being pregnant. Young women who have not had their first menstrual period by the age of 16 should be evaluated promptly, as making an early diagnosis and starting treatment as soon as possible is very important.

Treatment

Treatment depends on causes of primary and secondary amenorrhea. Oral contraceptives will be recommended by the doctor to treat the amenorrhea. Medications are also effective to treat, in case of amenorrhea developed by pituitary problems and thyroid.

Treatment for amenorrhea may include:

• progesterone supplements (hormone treatment)
• oral contraceptives (ovulation inhibitors)
• dietary modifications (to include increased caloric and fat intake)

In most cases, physicians will induce menstruation in non-pregnant females who have missed two or more consecutive menstrual periods, because of the danger posed to the uterus if the non-fertilized egg and endometrium lining are not expelled. Without this monthly expulsion, the risk of uterine cancer increases.

Prevention

Primary amenorrhea caused by a congenital condition cannot be prevented. In general, however, women should maintain a healthy diet, with plenty of exercise, rest, and not too much stress, avoiding smoking and substance abuse. Female athletes should be sure to eat a balanced diet and rest and exercise normally. However, many cases of amenorrhea cannot be prevented.